11D2118673 CLIA NUMBER - KROGER PHARMACY #402

Laboratory Demographics

  • CLIA Code: 11D2118673
  • Facility Name: KROGER PHARMACY #402
  • Facility Address: 4045 MARIETTA HIGHWAY
    CANTON, GA
    ZIP 30114
  • Facility Phone: 770 345-3645
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1013941855
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2118673
LAB Type Pharmacy
Facility Name KROGER PHARMACY #402
Street 4045 MARIETTA HIGHWAY
City CANTON
State GA
ZIP 30114
Phone 770 345-3645
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/13/2024
Certificate Expiration Date 9/12/2026
Facility Type Pharmacy
Lab Director CHUCK PAGE

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This page was last updated on: 9/29/2025